title: A novel robotic monofilament test for diabetic neuropathy.
abstract: OBJECTIVE
  The use of the Semmes-Weinstein (SW) monofilament test is recommended as a screening method for diabetic neuropathy. It offers an important chance to prevent further complications of diabetic foot. We aimed to develop a prototype Robotic Monofilament Inspector that can be used as a standard machine for screening of diabetic neuropathy.
  
  
  METHODS
  Development was divided into three parts: computer software, control box, and Robotic Monofilament Inspector. The examiner conducted the SW test (by hand and by robotic inspector), vibration perception threshold, and Toronto Clinical Scoring System without knowledge of patient information. The unpaired t test or Wilcoxon rank-sum test was used to determine the differences between independent groups in terms of continuous outcomes, while the χ(2) test was used to determine categorical outcomes. Agreement between the various diabetic neuropathy tests was measured using the kappa statistic.
  
  
  RESULTS
  The SW test and vibration perception threshold were more valid tests for neuropathy than the Toronto test. The robotic test was in excellent agreement with the two former tests and appeared to be valid (kappa statistic, 0.35-0.81). Another indirect evidence for the validity of the robotic test was the finding that diabetic patients with foot ulcers had a higher prevalence of neuropathy (77%vs. 38%). This might indicate that the robotic test was more valid than the manual test.
  
  
  CONCLUSIONS
  The Robotic Monofilament Inspector could be used as a simple screening machine. This prototype may be developed further for routine clinical use.
authors.affiliation: Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand. racwl@mahidol.ac.th
authors.forename: Chumpon
authors.initials: C
authors.lastname: Wilasrusmee
authors.forename: Jackrit
authors.initials: J
authors.lastname: Suthakorn
authors.forename: Claire
authors.initials: C
authors.lastname: Guerineau
authors.forename: Yuttana
authors.initials: Y
authors.lastname: Itsarachaiyot
authors.forename: Vera
authors.initials: V
authors.lastname: Sa-Ing
authors.forename: Napaphat
authors.initials: N
authors.lastname: Proprom
authors.forename: Panuwat
authors.initials: P
authors.lastname: Lertsithichai
authors.forename: Sopon
authors.initials: S
authors.lastname: Jirasisrithum
authors.forename: Dilip
authors.initials: D
authors.lastname: Kittur
mesh_terms: D017719:Diabetic Foot / Q000175:diagnosis; D003929:Diabetic Neuropathies / Q000175:diagnosis*; D003943:Diagnostic Techniques, Neurological / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D012018:Reflex; D012371:Robotics; D014110:Touch; D014732:Vibration